经导管动脉栓塞联合局部硬化治疗儿童四肢巨大血管瘤

Transcatheter arterial embolization combined with local sclerotherapy for the treatment of giant hemangiomas of extremities in children

目的总结经导管动脉栓塞治疗儿童四肢巨大血管瘤的疗效及安全性。方法选择2005-2008年四肢高流量血管瘤连续病例72例。年龄3～30个月,平均(6.7±2.3)个月;体重为5.8～12.0kg,平均(6.52±1.86)kg。对72例高流量血管瘤行经股动脉插管动脉造影,对血管瘤供血动脉超选择性插管灌注博来霉素碘油乳剂,其中40例再加PVA栓塞。残余病灶再行博来霉素局部硬化注射治疗。结果 72例高流量血管瘤中60例(83.3%)仅行动脉栓塞治疗,12例(16.7%)行动脉栓塞联合局部注射治疗。治疗后63例(87.5%)达治愈标准,9例(12.5%)好转,有效率100%。治疗结束后平均随访12.4个月,无复发病例。4例(5.6%)出现局部皮肤坏死,相应处理后好转。未出现肺栓塞、脑栓塞等严重并发症。结论经导管动脉栓塞联合局部注射治疗儿童四肢血管瘤疗效好、安全、大多无瘢痕、创伤小,值得临床推广。

Objective To evaluate the therapeutic effects and safety of transcatheter arterial embolization（TAE） combined with local sclerotherapy for the treatment of giant hemangioma of extremities in children.Methods From 2005 to 2008,TAE combined with local sclerotherapy was carried out in 72 consecutive children with giant hemangioma of extremities.The patients ranged in age from 3 to 30 months,with a mean of（6.7 ± 2.34） months,the weight was（5.8-12.0） kg（mean 6.52 ± 1.86）kg.Angiography via femoral artery was performed,which was followed by super-selective catheterization to occlude the feeding arteries of hemangioma with Bleomycin-lipiodol emulsion（BLE）.Additional embolic agent of polyvinyl alcohol（PVA） was employed in 40 patients.Local injection of BLE,used as the sclerotic agent,was adopted for the residual lesions.The clinical effects and the follow-up results were evaluated.Results Of the total 72 patients with high-flow hemangiomas,only TAE was used in 60 cases（83.33%） and TAE together with local sclerotherapy in 12（16.67%）.After the treatment,complete cure was obtained in 63 cases（87.5%） and favorable improvement in 9 cases（12.5%）.Conclusion As a mini-invasive technique,transcatheter arterial embolization combined with local sclerotic agent injection is a safe and effective therapy for giant hemangiomas of extremities in children.It is worth popularizing this treatment in clinical practice.